%0 Journal Article
%T Identifying, managing and monitoring laboratory test over-utilization for inpatients
%A Dozol A
%A Gana I
%A Cocagne N
%A Cornilleau B
%J Pratiques et Organisation des Soins
%D 2010
%I 
%X Aim: To confirm the over prescribing pattern of biological tests for in-patients, to identify the causes and to suggest improvement measures.Methods: Data have been extracted from the data warehouse of the Public Hospitals of Paris (Assitance Publique ¨C H pitaux de Paris). We used the value of each test determined by the French National Health Insurance Fund for Salaried Workers for reimbursement. Analysesof the volume of prescription of biological tests by the volume of activity per clinical department were performed. Finally, heads of laboratories and clinical departments have been invited for semi-directive interviews.Results: The average expenditure for biological tests per patient adjusted by the case-mix was higher in our hospital than in the sample of hospitals included the National Cost Scale (sample of voluntary public and private hospitals collecting detailed cost and activity data). The difference increased from 25% in 2006 to 55% in 2007. Comparing expenditure in biology by number of stays, we identified specific departments for which the increase of biological tests prescriptions was higher than the increase of their activity (number of stays). The main issues were: completeness and accuracyof data, in particular research activities were under identified; increased supply (new tests available and automatic instruments in clinical department); increased demand (new activities in particular in oncology) and new indications (BNP and troponin).Conclusions: The goal of this approach is not to spy on physiciansĄŻ prescribing behaviour but to develop tools to monitor and improve the efficient use of laboratories resources. New accounting instruments are currently experimented to promote stewardship and contractingbetween clinical departments and biological laboratories.Prat Organ Soins 2010;41(1):135-141
%K Laboratories
%K hospital
%K hospital
%K physicianĄŻs practice patterns
%K cost and cost analysis
%K laboratory techniques and procedures
%K health services administration
%U http://www.ameli.fr/fileadmin/user_upload/documents/POS102_Maitriser_la_consommation_d_actes_de_biologie.pdf